期刊
TRANSPLANTATION
卷 84, 期 4, 页码 498-503出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/01.tp.0000278094.41131.9f
关键词
heart transplantation; humoral rejection; vascular rejection
Background. Most humoral rejection (HR) episodes occur early after cardiac transplantation and are associated with hemodynamic compromise and poor prognosis. Late cases of HR (> 6 months after transplant) have been reported. We examined the differences in clinical characteristics and outcomes in patients presenting with HR in the early (< 6 months) and late transplant periods. Methods. A retrospective chart review was performed of all cases of HR at a single large transplant center from January 1, 1995 to March 1, 2006. Results. A total of 37 adult transplants had biopsy-proven HR; 13 patients had early HR and 24 patients had HR a mean of 5 yr after transplantation (range, 7 months to 17 yrs). Treatment for HR included plasmapheresis, cyclophosphamide, and rituximab. The age of the early and late humoral rejecters was similar (58 +/- 14 vs. 50 +/- 14 yrs; P=0.12). There was a trend toward more women in the early HR group (54% vs. 33%). Use of left ventricular assist devices was similar (38% vs. 33%). Early rejecters were more likely to have positive cross-matches (46% vs. 8%; P < 0.01). Patients with late HR had a coexistent diagnosis of malignancy, or significant recent infection in 50% vs. 8% for early HR, suggesting an activation of a nonhuman leukocyte antigen antibody-mediated immune response to an acute illness. One-year survival after the diagnosis of HR was 78% for the both groups (P=NS). Conclusions. Humoral rejection occurs now more frequently in patients with remote transplants and is commonly associated with the presence of malignancy or infection.
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